Extended versus standard pelvic lymph node dissection yields no difference in 3-year biochemical recurrence rates

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Extended pelvic lymph node dissection (ePLND) identifies more lymph node-positive prostate cancer cases than standard pelvic lymph node dissection (sPLND).
• The clinical benefit of ePLND on patient outcomes remains uncertain.
• This study compares 3-year prostate-specific antigen (PSA) recurrence rates after sPLND versus ePLND during prostatectomy.

Purpose of the Study:

• To compare 3-year postoperative PSA recurrence-free survival between patients undergoing sPLND and ePLND.
• To evaluate the impact of ePLND versus sPLND on prostate cancer recurrence.
• To analyze outcomes based on lymph node status and Gleason score.

Main Methods:

• Retrospective comparison of 162 patients (sPLND) and 142 patients (ePLND).
• ePLND included common iliac and hypogastric nodes, while sPLND focused on periprostatic, external iliac, and obturator nodes.
• Kaplan-Meier analysis assessed PSA recurrence; subgroup analyses were performed for node-negative and node-positive patients, and by Gleason score.

Main Results:

• The pN1 rate was significantly higher in the ePLND group (20%) compared to the sPLND group (6%).
• ePLND patients with pN1 disease received more adjuvant androgen deprivation therapy and radiation.
• No significant difference in 3-year biochemical recurrence was observed between sPLND and ePLND groups, including subgroup analyses.

Conclusions:

• Pelvic lymph node dissection (PLND) did not provide additional therapeutic benefit in terms of PSA recurrence.
• Despite higher detection rates of lymph node-positive disease and increased adjuvant treatment use, ePLND did not improve patient outcomes over sPLND.
• The therapeutic value of ePLND over sPLND in prostatectomy requires further investigation.